What You Must Know about Zika and Other Diseases When Trying to Get Pregnant

What are the dangers to you and your baby if you or your partner get Zika or other diseases while you are pregnant? What about before you are pregnant? What can you do to protect your baby from Zika or other infectious diseases? Host Dawn Davenport, Executive Director of Creating a Family, the national infertility & adoption education and support nonprofit, interviews Dr. Franasiak, a board certified Obstetrician Gynecologist, board certified Technical Supervisor in Embryology and Andrology, and lead physician of RMA’s South Jersey – Marlton Office.

[00:00:00] It’s a funny thing this year in the news because it surprised me. We started getting a fair number of questions about it and quite frankly it surprised me. And then we as you know we have a huge online community where we always post about the show topics which let me pause for a moment and remind people we would love to have you join us on our social media. You can connect with me personally Don Davenport on Facebook or you can connect with our Facebook support group which is Facebook dot com slash group slash. Creating a family or just type in the words creating family and you’ll find. Or of course you can go to our page Facebook dot com slash creating a family anyway just the plug we would love to have you with a huge. One of the top online influencers worldwide in the area fertility and we would love to have you join us. All right. So we started as we posted about the show and I get this e-mail from somebody saying is still a thing. And I thought that was actually more of a response. I was surprised we were getting questions about it because we’re almost never hearing about it in the news. It was such a hot topic really the last two years. I guess 2016 and 2017 it was like this time of year and in particular. Gosh. May and June it was like you couldn’t pick up any type of mass media and not not read about it. And I’m not seeing it this year. So does that mean that we don’t have a doctor for days yet.

[00:01:24] Does that mean we don’t have to worry about it now head on. I think you’re a really good question. It’s an interesting thing in our world because we’re so connected there’s so much news and so many sources of news that you know those are often the things that drive various aspects of what we think about in terms of trying to get pregnant and trying to get pregnant safely to the forefront of our mind in the news oftentimes has a relatively short attention span and I think that can go with what is most exciting and will grab the attention of most. You know I think it’s important for us all to be reminded that the Zika virus was not just discovered several years ago and it has not gone away and it’s certainly something that we think an awful lot about as fertility providers and reproductive specialists. You know the Zika virus is part of a family of viruses and it’s primarily a mosquito borne and spread and it was actually named for the Zika forest which is in Uganda and the first virus was actually isolated many years ago back in 1947. And we know that it had an effect on the fetus back then. So it’s certainly not garnered the international acclaim and news media attention that it did in 2015 and 2016. But we do know that it did have some impacts and there just wasn’t as well studied.

[00:03:05] And part of the issue was that it was very confined so it was first isolated in nineteen forty seven and in the entirety of the 1950s onwards really truly it was known to really only occur in a pretty narrow band from Africa to Asia and it was oftentimes a little bit more known for some of the viruses that it’s related to. And I think that probably got more attention for the patients who suffer from Zika virus in those areas. The Zika virus is related to things that many of your listeners may have heard from heard of such as dengue fever or yellow fever or Japanese encephalitis or West Nile virus and these are foreign intervention. I think chicken Gunder under with that in there because you hear about that when as well you do and I think a lot of these things you hear less about the impact of pregnancy outcomes and more of their impact on the people who contract these diseases. The somewhat fascinating thing about the game is that it actually causes relatively mild disease. If an adult man or woman were to contract it and it has this interesting property of having issues with pregnancy outcomes and the number of different pregnancy outcomes if it’s if it’s contracted during pregnancy which is really where it got a lot of it’s kind of it kind of infamous news over the last couple of years. Well sometimes not at all uncommon for adults to not have any symptoms are not symptoms that they even notice may be the more accurate way to say it which I think is one of the reasons that nobody really thought too much about it it was kind of like oh yeah well you know I’m not sick so what do I care type of thing until it made the news. Like you said a couple of years ago for a cluster of birth defects and when they talk about those.

[00:05:15] Well let’s go and talk about this. So what again what was probably not new but it certainly well maybe it was new because I remember hearing about a epidemiologist I believe it was in Brazil wasn’t it that noticed a what looked like a cluster of microcephaly small brain size and small head size and newborns and am I remembering this correctly. Dr. René’s you are. And you know whether or not this is something brand new or something that’s been going on for some time and just has not been noticed is not terribly clear. And I think that what you had mentioned before if I might just go back for a moment to the fact that many people adults don’t HAMSON I think this is going to be an important point for future conversations that we may have in the show about what we might be doing to best protect ourselves when we’re working towards getting pregnant. You know the Zika virus causes very mild symptoms as you noted and many people don’t even realize they have it. So you know the symptoms that you can get are mild fevers or headaches or skin rashes or a little joint pain. Honestly there’s not anything that can be clearly identifiable that you would say gosh maybe I have an infectious disease it could be just Avars some travel kind of feeling a little off. Yeah it’s really only last for a short period of time as many as two to seven days and people contract Zika.

[00:06:51] Only about one in four of them ever exit exhibit any symptoms at all but just because they don’t have symptoms that doesn’t mean that they are not at risk for potentially passing on that virus to a pregnant woman who’s pregnant to the child. Yeah. In fact I read some research that indicated that there was. I mean you would normally think gosh if I have symptoms I have the disease I have I got it worse I got a worst case of Zika therefore my my baby is going to stands a greater chance of being impacted by it. I read some interesting research which everyone you can find on the CDC Web site and get into it again at CDC dot gov slash pregnancy slash sticker anyway and it indicated that the risk of impact of the birth defects on the baby are really basically no different whether or not the adult the mother showed symptoms or not which I thought was fascinating. And I think that that is saying you know I think that one of the things we don’t have a clear understanding of all the risk factors that go into this until certainly we learn more. We want to be very cautious. And I think that it does stand to reason and it is the best of our knowledge that the severity of Sinmun do not correlate with the potential effects in the child. So really a lot of what we will talk about here will be primary prevention meaning that if thinner is even a risk that Zika virus may be in the body of the man or the woman that we seek to avoid having active forms and getting pregnant till the time has come that we feel the Zika virus has been cleared whether or not it was present. OK so let’s talk a little about where we know that is carried by a particular mosquito.

[00:08:55] So where have where where are the areas of concern that the mosquitoes may carry the Zika virus. Let’s start with the U.S.. Are there any dates in the U.S. that have recently reported. And again everybody to know you’re going to have to check the CDC Web site CDC dargah slash pregnancy dot slash Zeka and there’s a map there and you can actually type in the city the area code of where you’re going and they will indeed they’ll give you an indication of the risk. However just in general are we or are there any places in the U.S.. People need to be cautious great questions. As you noted the Zika virus is transmitted by mosquitoes it’s a very particular type there are typically date time biting mosquitoes and it’s EDI’s mosquito. There’s two different subtypes say Hedy’s Egypt and EDI’s album Pink deaths and these these mosquitoes and the virus that they carry have spread eastward around the world from Africa to Asia. You know across the Pacific Ocean and now into South America the Caribbean and parts the United States and to your comment the CDC Web site is the very best place to go for updated information. This information changes frequently. And so any I actually looked at it this morning so we could provide up to date information for anybody who is listening to this as a delayed broadcast please do not take this as detailed information. Go to that ABC Web site and look at the map that they have.

[00:10:46] If you are planning to travel today to an area or are living in a potentially affected area as of this morning though Don in looking at the CDC website particularly focusing in the United States as you noted there are two states which are designated as having previously reported presence of the Zika virus and mosquitoes which transmit it. And that is in Florida and in Texas but currently there are no states which have active guidance against the Zika virus or active guidance of for active transmission in the United States presently. You know we had an actor and slight connection in that one of our other partners Childers connection is and is an adoption agency in Texas. And I think it was last year they reached out to us to help them find a help us promote and spread the news that they had a baby whose mother had had Zika and the baby was born with microcephaly and the baby was put up for adoption and they were looking for a family to adopt this little boy. And I’m happy to report that we spread the news and I mean almost like they were inundated with people stepping forward and they found a family who was located in a place where they had good medical care and good insurance and all that and that little baby found the home almost immediately in fact went home from the hospital with the. A happy ending. Yes. And this was probably would have been in 2017 which means that the pregnancy was in 2016. So anyway yes. So Texas has had a few cases of birth defects. OK so we’ve talked about in the U.S. and you mentioned generally I don’t know.

[00:12:43] Did you mention when you’re talking about outside the U.S. did you mention Mexico because the entirety of Mexico except for those areas that are too high in elevation the mosquito won’t last the entire area. Mexico is considered a Zika prone area. You may have mentioned that so Mexico. No I didn’t yet but you’re absolutely correct. So focusing just on areas that are in close proximity to the United States there are many areas of active Zika virus transmission and I think this is an important thing for listeners who may be living in those areas or perhaps more commonly those who are seeking to build families and are perhaps also looking to travel and take vacations. These are pretty common vacation spots in Mexico and in the NBN. And that presents a big problem for folks trying to determine when it may be safe to begin conceiving once again after traveling to some of these areas where there is according to the CDC Web site active transmission of the Zika virus. You know you and I were both at a conference recently that Pacific Coast reproductive symposium and I ran into a doctor I believe it was from New York and who the reproductive endocrinologist and he said I had no idea that many people went to Mexico on vacation until they pup made me laugh. I thought I guess you’re right. You know these are people who are taking up even thinking about taking a baby moon you know getting in one last vacation before they you know do that next round of treatment or something anyway. Yeah. That’s the thing. I think it often gets people is thinking about getting out of the country usually and think about it someplace warm and nice is where you’re thinking like those off those might be places that where the Zika virus is prevalent.

[00:14:42] So yes something to worry about. We’re going to talk. Well let’s go ahead and talk about what people can do. Let’s say you do want to go to the beach in Mexico which sounds nice right about now and you want to enjoy some sun and sun. Should you do that if you’re if you’re thinking about trying to get pregnant or for a lot of our audience. There are scheduling cycles or IVF cycles or thinking about going a lot of people thinking about switching from their Obied UI and into a reproductive endocrinologist or infertility. So should you just not go to any of these places. You know there’s a very interesting question Don I think that you know one of the things that I’ll say is that you know fertility for folks is it is a tough journey and they give up a lot lot in their personal lives in order to be able to pursue this goal. And you know it just seems a little bit cruel to take away all possible fun and relaxation. So you know I wouldn’t go so far as to say you should just not travel. But I think there are a couple of general guiding principles that are important. Number one you know if you are seeing a man or a fertility specialist involve them in your plans it is it is a common thing in our practice. Now for us to routinely ask patients about their upcoming and previous travel plans as a result of the Zika virus and Zo involving your health care professionals in your plans allows them to give you the most up to date information that they can.

[00:16:32] The other thing that I would recommend is begin educating yourself as we’ve mentioned a couple of times the CDC Centers for Disease Control website provides great information. Number one it can help you identify whether or not the area that you’re looking to go is is a risky place and places you at risk for potentially contracting Zika. And if that is the case it talks about general protection. Anybody going to a place with the active Zika virus needs to undergo and take careful here to have you know active mosquito prevention. And these involve things like insect repellents covering of your skin mosquito proofing your home or or hotel area. So certainly you know it makes it challenging because many of the things you as you go into the Caribbean or Mexico for first son are not compatible with covering your skin up and staying indoors. But mindful to try to do those things to the best of your ability. OK. So that metho preventing bites is what you’re suggesting. One of the things that certainly when I was pregnant we were told not to use any form of Deet. Is that so. Is that still the recommendation. Are the which I should mention DEET is a common ingredient in many mosquito repellent or has the thinking evolved now to allow for use of d during pregnancy. Actually the CDC USA Today addresses this and deliver a list of safe mosquito prevention that is available for folks. So that’s why typically more patients do OK. So avoid if you’re going to travel to an area where Zika has been known to exist. Protecting yourself from bites is your best bet.

[00:18:40] One of the interesting things to me and maybe this is this is common and this is something that I wasn’t all that aware of until a couple of years ago when I started reading up on Zika is the risk of exposure to the woman through intercourse with her husband so I would assume that means in the semen that the Zika virus is pregnant. I mean it is present. And so let’s talk about that. The risk of sexual transmission of the virus from the man to the woman or I guess the way that they’re concerned would be from the man to the woman. Sure. So you know the Zika virus has been looked at in many different areas of the body it’s been found to live in our blood to live in our urine to live in semen to live in saliva and to live in the vagina. And there’s been documented transmission of the Zika virus from a pregnant woman to her her child in her uterus through sex and through blood transfusion. So certainly things are are of great concern and I think that one of the biggest things for us of course when folks are trying to conceive is the risk of sexually transmitted infections. And Donna I think going back to what we talked about at the beginning. So important to remember that if you travel to an area that is potentially infected according to the CDC website whether or not you have identified a mosquito bite during that time or have infections or signs of an infection.

[00:20:24] We would still caution and consider that you would be potentially at risk for sexually transmitting the Zika virus because again as many as one in four individuals with the Zika virus have no symptoms at all. And we do not have great ways of testing individuals and that has been one of the challenges for folks and has led to evolving recommendations. The most current ones again are on the CDC Web site but they involve trying to prevent sexual transmission by either abstaining from sex for a period of time after you’ve gone to a Zeka place or using condoms. So trying to prevent Zika virus transmission with condoms. It’s a little bit it can be a little bit confusing for folks because the Zika virus can live for various amounts of time in the man and the woman and place you at greater risk down the road for transmitting it to your child if you are to become pregnant. And the current recommendations are that if you travel to a Zeka area that you should abstain from sex or use condoms. And it depends upon the length of the length of time depends upon who were concerned about might have contracted Zika. So Zika can live for a fairly long period of time in man a symptomatically and then be in the semen of a man only travels to the infected area. We would recommend waiting six months time prior to conceiving if I did hear that say it again say that again that’s the part that blows people away when we when this comes up to say that part again. Yep. And so in six months is a period of time that we recommend waiting. If the man only traveled to a Zika infected area.

[00:22:35] If that’s unbelievable really I mean that’s something that people must know about and before they if they’re actively trying to get pregnant or think they’re going to be sent. All right so what about the with the woman is the one who this travel is traveling prior to. Yes there there’s a shorter period of time because you would. The virus itself would be cleared and you would not be worried about delayed exposure in the semen and potentially contracting it down the road. And so what we would say would be it would be two months after the woman travels to an area that has Zika confirmed or that there is a concern until that until they should actively begin conceiving. And if they both travel on vacation we kind of go with the most conservative. So of course the man and the woman would be potentially at risk. So the man is the most conservative and we’d recommend waiting six months if they both traveled and so in this case because it’s many in our audience will be doing IVF for UI and so the same will be prepared. Is any of anything in the preparation would kill the virus so that they have less to worry about. So there a lot of data which you can read down there about semen in preparation for various infectious diseases probably the most well-known being the Human Immunodeficiency Virus or HIV. There’s not a lot of data about what we see with the virus transmission or titers in semen Prep’s for in vitro fertilization. Are you guys. And so we actually don’t have recommendations or believe that we can tell patients that it decreases their risk. One thing that can be done.

[00:24:35] And one thing that we oftentimes will do is that if a couple is undergoing fertility care and the man is traveling for work or for vacation alone we can actually freeze his sperm before he leaves and use that sperm for the fertility care knowing that it was obtained prior to the time that he was potentially exposed to the Zika virus. And yes science if that’s something to consider if you’re already and even if the couple themselves are going to be traveling they would still if they’re going to use the frozen sperm they wouldn’t have to they would have to only wait I guess at the two months the current recommendations two months rather than six months. OK. Now what we’ve been talking about up to this point is exposure prior to pregnancies which the concern that the the virus would be in the woman’s bloodstream in which the fetus would be exposed if she became pregnant. So that’s what we’re talking about now. But what about if the woman is pregnant. I’m assuming that there’s still a risk to the fetus and perhaps even more so if she can get contracts. The Zika during pregnancy of course so that would be the concern with with any of these that it’s becoming pregnant or being already pregnant and contracting Zika virus have you have a fears that is there you have an increased risk of various pregnancy complications that has been associated with increased risk of having miscarriages or having an intrauterine fetal demise. So a late term death of the child inside the uterus. It’s also been associated with growth problems.

[00:26:29] He is going to have small children or placental problems and then the big thing that has been in the news that people are mostly concerned about is what’s been termed congenital Zeka syndrome and that’s where the Zika virus goes and causes abnormalities in the baby’s brain. And you can see those children with small heads or microcephaly or other birth defects. And for those children we see about 4 percent having a brain and normality or 4 percent having a birth defect if they have an active Zika infection during pregnancy. Okay so for if you were to have Zika during pregnancy you have roughly a 4 percent risk that the child will have birth defects associated with Zika. Does it does that risk. These are confirmed cases. This is from a relatively large study several thousand confirmed cases of Zika so not suspected but confirmed. OK so does it matter when in the pregnancy what trimester you get you contract Zika. Does that affect your Guergis for your infant. You know I don’t you as the fertility doctor I’m on the front side of things and care for folks who have a very early pregnancy ages. I don’t know of data that changes your risk for congenital Zika syndrome. Throughout the course of pregnancy if you were to contract Zika during pregnancy very likely you would be under the care of your obstetrician gynecologist. And I would recommend that you and that individual work with the high risk maternal fetal medicine doctor and perhaps an infectious disease doctor in order to undergo additional monitoring of the child throughout the course of pregnancy. I actually did read some of the research. And and again you will find this that the CDC CDC slash pregnancy slash Zika Web site. I did read some of the research.

[00:28:45] And I’m going to be paraphrasing grossly here but basically there is a slightly increased risk in the first trimester but there is still a risk in the second and the third trimester so that’s kind of a cliff note version of that would make a pretty good sense to me as much as fetal brain development is occurring in that first term answer but continues to evolve in some of the things that we see with growth problems in the placental problems can certainly occur throughout the rest of pregnancy. Yeah. Yeah exactly. That makes it makes good sense. So for those people. So if you don’t have symptoms I think I think you said before we don’t. Is there a test a blood test that we can do let’s say you didn’t think about it you went to Mexico and you’re coming home and you really don’t want to wait six months assuming that you’re and your partner a male partner was there as well. So is there a blood test. I believe you said the testing is not particularly accurate. Is there anything you can do to say rule out or rule in or out whether you are your spouse or your partner was exposed during the preconception phase where people are looking towards getting pregnant. There really isn’t a surefire way. There are blood tests out there that can be obtained and certainly if you are already pregnant there was concerned.

[00:30:15] It is very likely your obstetrician and your high risk obese doctor would have ordered these tests in conjunction with infectious disease but the safest and surest thing at this point is to abstain from intercourse and trying to become pregnant during the period of time where there’s potential risk. So Vereide patients I’m not able to order a test that can reassure us with confidence that it is OK to proceed with pregnancy if indeed we are in a time period that there is risk for transmission. Yeah given the risk. Yeah I hear what you’re saying and if you’re already pregnant that’s a different issue perhaps. OK. Excellent. All right. Before we move on to talking about other diseases I wanted to talk about some of our partners creating a family. As you know is a non-profit and we exist quite frankly because of the support of our partners who believe in our mission of bringing unbiased medically accurate information to the patient community. And one of our wonderful partners is Reproductive Medicine Associates of New Jersey. They are a recognized scientific and patient care leader in the field of infertility. They have 10 offices and 21 physicians throughout New Jersey and they maintain an IVF delivery weight well above the national average and they offer the latest and validated technical solutions to help hopeful parents increase their chances for success in the shortest time possible. And we think our new jersey for their support their long term support of the show. We really do appreciate it. Now moving on to talk about other other diseases that can affect a mom. We got a question from a woman and I’m going to use our initial bet her request as she said I am very prone to vaginosis. We are trying to get pregnant and will probably be referred to our fertility clinic this spring.

[00:32:10] I am worried that I will get an infection while either pregnant or trying to get pregnant. Do you have suggestions of what to do if I get one. How to avoid it and what it will do to the baby if I get that illness. So let’s talk about let’s start with this question is that you this is I guess just natural infection right to be caused by any number of things that it is. You know bacterial vaginosis is a pretty so when it’s all said and done a pretty broad diagnosis. So I think important to note that that are in our bodies as we have discussed on a previous call on the microbiomes our bodies are quite invested. In fact we have more bacteria in on our bodies than we do our own cells and the vagina is a place where bacteria live normally that they actually win in the correct balance or are good for health and good for pregnancy. There can be alterations of the fact that Vaginal Microbiomes and this is termed bacterial vaginosis for patients that get this disease is typically screened for in your gynecologist’s office usually through a vaginal swab where they look for changes in the national ph which is the acidity in the vagina which is regulated by many of the bacteria and they also look for presence of these bacteria on the empathies fuel cells of the vagina often dines is then treated with antibiotics and nerve to try to restore the normal balance of of the bacteria in the vagina. And you know doses is not recommended as one of the routine screening.

[00:34:06] So many folks who are looking to get pregnant will be screened for a number of infectious diseases bacterial vaginosis not one that we recommend screening for any asymptomatic men and women who have symptoms such as Badgerow discharge itching in the right area et cetera. Screening would be recommended and if it is identified during pregnancy then you would have this be treated as bacterial Valentinos this is associated in someone with a risk for preterm delivery. But again this is not one of those routine infectious diseases which are screened for patients. Really only in those that are symptomatic and that she has been prone to it in the past. She could talk with her obstetrician and just say you know I’ve been I’ve had this in the past. So should we be aware of this and and she will either test for it or will make a decision based on that. Let me put in a plug for the show doctor for NACA. Just mentioned it was really one of my favorite ones. The title The subject matter was how the human microbiomes affects fertility. It was a couple of years I think with the last show you were on and it was a couple of years ago and his truly one of my favorites. It is fascinating. So just go to our Web site creating a family dot org and search for micro biome or search for Naisi at Jason for Naisi. And either one it will pop up really really interesting. Just fascinating subject. OK. So let’s talk about sexually transmitted diseases since we’re kind of talking about that area of the body. What about herpes.

[00:35:58] What is the risk with for a mom that has herpes so you know that’s a very good thing now you know I think it’s important to note the herpes virus comes primarily in two types of forms. The herpes virus one and herpes virus two and herpes virus one is the most commonly associated with things like cold sores and things and infections of herpes of the mouth whereas herpes virus to associate more with genital herpes infections. What we typically do you know many patients will come knowing that they’ve had a risk of this in the past. It is also not one of the diseases that is routinely screened for asymptomatic pregnant women. However if there is concern that herpes virus particularly of the general tract has occurred it’s important for you to contact your health care provider and go in for an examination and have that area tested. Those can be tested for the virus and if it is positive you ought to be treated for that virus infection and subsequently are placed on suppressive therapy so that the infection does not come back during pregnancy. One of the biggest concerns for a herpes virus in pregnancy is active infection. At the time of delivery because the child passes through the eyes of the National canal and birth canal it may come into contact with active lesions which could result in the child contracting the herpes virus. Neonatal herpes is a bit more concerning and scary than it is in the adult. Exactly. You don’t want to have an active infection during birth. And again your obstetrician can talk with you and work with you during pregnancy to hopefully prevent your being having an active infection at the time of birth.

[00:38:03] What about gonorrhea or syphilis that we don’t hear about them as much anymore but are they concerned if a woman knows. I would assume if she knows she has them she’s going to be treated for them. So it seems a little bit of a moot point here because is obviously going to want to be treated but nonetheless what about the shores. So I think that in terms of some of the more common infectious disease we see there are sections trans than in the United States gonorrhea and chlamydia are kind of the two that go hand in hand. And there are recommendations for routine screening of all pregnant patients for gonorrhea and chlamydia. So for patients who come into prenatal care and for those even who come into care seeking to get pregnant many more have a screening for gonorrhea and chlamydia. And you’d screen all patients in the first trimester at their first prenatal visit and if they are at high risk for contracting gonorrhea or chlamydia then they would be rescreened in the third trimester closer to the time of birth. And if they have a positive test whether it be from a cervical swab or from a urine test they should be treated for this infection and confirm that they have cleared this infection. Their partners should also be screened and tested and treated if they’re found to be positive. And so it is important that you speak with your doctor and those will be fairly routine thing to screen for during pregnancy in order to optimize the pregnancy. We had a question on chlamydia. Let me read that. Now she says I have had chlamydia twice in the past. As far as I know I don’t currently have it.

[00:40:02] I’m trying to get pregnant do I need to worry about it for my baby. So this is someone who has had it twice in the past. I would assume she is considered at risk for it. So this is certainly information she’s going to want to share with her obstetrician. But is there anything before pregnancy should she be sharing this with her. I don’t know if she has seen her fertility doctor or not. What should somebody do in her situation. Yes typically with MENEA those that are under arrest are ones that have knew or have had multiple sexual partners or have a sexual partner who has a sexually transmitted infection any sexually transmitted infection or one that they’ve had themselves. So I think that if they’re working towards getting pregnant and having a conversation with their doctor and determining whether or not screening for sexually transmitted infections prior to becoming pregnant is appropriate. And if any of those are positive she should be treated for the chlamydia and have a test of cure in about three to four weeks time after the treatment and then be retested once again three months later to ensure that there is not a new infection or a recurrent infection with your infertility or medical professional. And thank you so much. To Dr. Jason Franasiak for being our guest once again on creating a family.

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